[Generalized secondary peritonitis: predictors of in-hospital mortality and survival and mortality evolutive links]

Abstract

Background: The knowledge of mortality predictors and evolutive variables linked with in-hospital death can help us to optimize corrective procedures.

Objectives: To identify independent predictors of in-hospital mortality and survival, and independent evolutive links with death in patients with generalized secondary peritonitis (GSP).

Methods: Two hundred and forty-two patients admitted into the hospital due to GSP were followed until in-hospital death or hospital discharge. Mortality and survival predictors were identified from several variables evaluated at the time of admission and evolutive links to death from evolutive variables.

Results: In-hospital mortality was 16.5%. Independent mortality predictors were APACHE II > or =16 [OR=31,9 (IC 95% 10.5-96,5)] and chronic renal failure history, with specificity (1) An appropriate nutritional condition was the only survival predictor [OR = 0.2 (IC 95% 0.1-0.6)]. The highest contribution to APACHE II predictive power came from the deterioration of blood tests values and vital signs, followed by age, sensory condition, and medical history. Independent evolutive links to mortality were multiorganic dysfunction involving three or more organs [OR = 63.2 (IC 95% 18.4-217)], hemodynamic failure and septic shock, and necessity of vital support with mechanical ventilation and/or inotropic/vasoconstrictor drugs.

Conclusions: In generalized secondary peritonitis the independent predictors of in-hospital mortality are APACHE II score > or =16 and chronic renal failure history, not very useful due to the low prevalence. The only independent survival predictor is an appropriate nutritional status. The evolutive links to mortality are multiorganic dysfunction involving three or more organs, hemodynamic failure and septic shock, and necessity of vital-support with mechanical ventilation and/or inotropic/vasoconstrictor agents.